Once a woman has gone through a double or a
single mastectomy to remove cancerous tissue - the reconstruction typically
consists of three different phases:

First Phase:
the breast mound is rebuilt

Second Phase:
the nipple/areola complex is formed

Third Phase:
Nipple tattooing or micro-pigmentation

Reconstruction of the actual nipple/areola
complex is done in two phases and it is the final step in with breast
reconstruction. There are patients who are satisfied after their primary
breast reconstruction and decide to forgo any further surgical procedures and
not have a nipple made. There is also the option where the patient can
just elect to go for micro-pigmentation of the areola only. This is where
the areola is tattooed on to resemble the "areola portion". For most
patients, going through the final stage of having the nipple/areola complex
reconstructed is the final touch on the newly created breast.

Although reconstruction with the use of
breast implants is the least
extensive of all breast reconstruction procedures, there are still
some plastic surgeons that still prefer the reconstruction process
with the flap technique. Although there are choices with how to
achieve the end result of reconstruction, each woman should be
assessed individually with their own preferences.

Breast cancer normally requires a timely treatment plan after
diagnosis; however most women find that they have enough time to
research treatment options and reconstructive advances before the
actual breast cancer surgery. It is a very common fallacy that women
have to wait a year or longer to begin the reconstructive process.

Having to undergo chemotherapy after mastectomy could delay
reconstruction until the chemotherapy is completed. The
majority of women elect to begin the reconstructive process soon
after the actual breast cancer surgery, including some patients who
elect to have this done at the same time as the mastectomy.

Most surgeons recommend waiting until the newly
reconstructed breast is fully settled and healed in order to optimize the
positioning of the nipple/areola complex. This procedure is normally done
anywhere from three to six months post operative after the primary
reconstruction. This is done as an outpatient procedure at either a surgeon's
accredited surgical suite, outpatient surgery center, or day surgery at a
hospital.

Nipple reconstruction can take anywhere from one
to two hours to complete, however; the times might be different based on the
method that is chosen. Nipple reconstruction is a permanent procedure,
however; the areola which has been treated with a tattoo might fade out a little
bit with time. This part of the procedure can easily be touched up at any
time. Nipple and areola reconstruction can be done right in the plastic
surgeon's office using local anesthesia and sedation.

The nipple mound is normally skin that is taken
from a flap on the new reconstructed breast. The graft technique involves
harvesting skin from a donor site separate from the reconstructed breast.
The areola is done with micropigmentation or a tattoo or can be reconstructed
from another skin graft located on the body.

If the patient has had only a single mastectomy,
the surgeon has to evaluate the coloration, skin texture, size, shape and the
location on the breast mound where the reconstructed nipple/areola complex will
best match the other side.

With a patient that has gone through a bilateral
mastectomy, using local tissue flaps on both sides is a good surgery option
since both nipples will look similar.

Tattooing or micropigmentation of the
nipple/areola complex after breast reconstruction can give the newly
reconstructed nipple a very natural appearance. This part of the nipple
reconstruction phase is done under a local anesthetic and usually only takes
approximately 30 to 40 minutes. Reconstructed nipple
and areola have very little sensation.

Using an electric needle that pulsate 150
times per second, the micropigmentation artist (which can be either a surgeon,
nurse, aesthetician or an independent tattoo artist) - carefully mixes the
pigment dye to match the pink, brown, or coral coloration of the woman's
remaining nipple, lips, or a pre-operative photo of their original nipples.

As with all tattoos, if there is scar tissue, the
pigment has a harder time taking in these areas. In order to make these
areas accept the pigment or dye - microdermabrasion or laser treatments might be
suggested for the scar areas.

After having your session with the
micropigmentation artist for your new areola you will need to keep Bacitracin
(Antibiotic Ointment) or Aquaphor and a gauze dressing placed inside your bra or
tape to your newly reconstructed breast.

The color of the pigmentation of the tattoo
will appear much darker at first. Micropigmentation is done darker as you
end up losing 40% of the pigmentation as you heal and exfoliate. The blood
and some of the ink will exfoliate off over the next several days. It is
during this time of exfoliation that the true color of the tattoo will be shown.
Keeping the area moisturized with the ointment is important. Healing of
the tattoo will be faster if you can let the area "air dry" for a period of time
each day.

If you find the tattoo has gotten too light
during your recovery, having another session to have more pigment added is very
common. Your tattoo will last longer if it isn't exposed to UV Light or
sun-light.

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Micro-pigmentation to the Areola

Comparison of the Nipple/Areola Reconstruction and Micropigmentation

Another option for nipple/areola reconstruction is to use a
graft of skin from another location of the body, usually your
inner thigh or waist. Skin from these areas of the body has a
natural tendency to heal darker when it is grafted. Areola
grafts are performed in the operating room.